Analysis of student health incident data highlights behavioral health issues as experienced in schools. In SY 2012-13 there were 278 injury incidents related to aggression, compared to 345 in SY 2011-12. Student aggression is a substantial cause underlying significant injuries at the secondary level. It is important to note that these numbers do not reflect the total number of aggressive incidents on campus, but rather the most severe incidents that involved SHS staff. Nor do they reflect disciplinary events related to aggression, which are tracked and addressed separately.

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Elementary student injury incidents are more likely the result of non-aggression-related incidents such as playground falls. The total count of aggression-related injuries decreased in SY 2012-13 to 278, from 345 the prior year. This was driven primarily by a decrease among high school students. Of the 36 EMS contacts across the district due to injury, fewer than 6 involved aggression. An additional 31 students were taken to the emergency room by a parent following an aggression incident.

Social Emotional Learning and Aggression Prevention Efforts in AISD

Social and Emotional Learning (SEL) is a fundamental research-driven curriculum approach based on the tenets of self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Students learn critical life skills such as recognizing and managing emotions, solving problems effectively and establishing positive relationships. SEL creates the foundation that lets all other learning occur. SEL reaches beyond the classroom to all aspects of life. Skills are integrated in academic lessons and practiced to enhance the climate of the school. Out of school time providers and parents reinforce SEL skills as well. AISD is a recognized leader in urban education and one of the first districts in the nation to commit to the development of the whole child by incorporating social and emotional learning. During 2013-14, SEL is being delivered to 73 schools serving 55 percent of the students in AISD.

There are several other evidenced-based anti-bullying, violence prevention, and mediation programs being implemented in AISD. One example is the Safe Start program, a collaboration between SHS and SafePlace to encourage healthy dating behavior, reducing vulnerability to partner and domestic abuse.

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Based on incidents involving SHS staff, aggression is an ongoing concern among middle and high school aged youth while substance abuse is more prominent for high school youth. Aggression-induced injuries are not the only behavioral health incidents that are tracked and trended by SHS. Substance abuse, suspected abuse/neglect of students and student suicidal intent episodes involving health staff are also monitored.

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SHS and AISD staff participate in community adolescent suicidality prevention and postvention efforts. School RNs have been trained in the ASK protocol. An additional area of student behavioral health concern and consequent professional development is student depression and non-suicidal self-injury. SHS has worked with Seton Shoal Creek Hospital to insure post-discharge continuity of care for students hospitalized for significant mental health needs.

In addition to the SHS data, over 50% of students seen by the Travis County Juvenile Probation Department, many of whom attend AISD, are identified with mental health issues; and within AISD more than half of students receiving disciplinary placement at the Alternative Learning Campus (ALC) prior to SY 2011-12 were identified to have a behavioral or mental health issue. In SY 2012-13 AISD implemented a new policy to decrease ALC placements through enhanced campus-based services with behavioral health as a significant consideration affecting staffing at the campus level. The annual AISD School Safety and Substance Use and Survey (SSSUS), completed by a random sample of secondary students, provides information on the general behavioral health of AISD students. Behavioral health maps addressing school and community safety, substance use, discipline, clinical care and community supports are available atwww.cohtx.org. Analysis of more recent SSSUS data includes neighborhood level (Zip code) results.

Understanding and responding effectively to student behavioral and mental health needs is an area of on-going collaborative development for SHS, AISD and community partners. Professional development in identifying and addressing behavioral health issues has increased, and individualized health care plan development processes have been refined.

Campus Based Counseling Referral Centers

Responding to student behavioral health needs must be systemic and systematic. During SY 2011-12, the final year of the Safe Schools/Healthy Students ACCESS grant, a pilot was developed for a campus-based counseling referral center (CBCRC) on one high school campus. A fulltime licensed, Medicaid-certified therapist, a PhD Psychologist employed by Lone Star Circle of Care (LSCC), was embedded at Crockett High School, providing clinical assessment and therapeutic counseling on-campus. AISD staff in collaboration with parents/guardians identified students whose behavioral health needs were interfering with factors such as attendance, grades, and classroom behavior. This integration of allows for the delivery of crucial behavioral health services at the place where students spend most of their waking hours: at school.